The objective of this study will be to define new factors of adrenocortical origin in human hypertensive disease. Efforts will be concentrated in a juvenile hypertensive syndrome resembling primary aldosteronism but with subnormal production of all known steroids. An abnormality has been detected in these patients consisting of a defect in the reductive metabolism of the steroid ring A, with accumulation of corticosteroid 4,5-dihydro metabolities, and the excretion of 3-keto metabolites in the urine in unconjugated form. A second aspect of the defect is an abnormal predominance of 5 alpha-dihydro epimers relative to the 5 beta forms. Preliminary results indicate that the mineralocorticord activity of 5 alpha-dihydrocortisol may be an etiologic factor in the hypertension of these patients. BIBLIOGRAPHIC REFERENCES: Ulick, S. and Ramirez, L.C.: Steroid patterns in a juvenile hypertensive syndrome. In: M.I. New and L.S. Levine, eds. Juvenile Hypertension. Kroc Foundation Series Vol. 8. New York, Raven Press, 1977, p. 165. Rosler, A., Rabinowitz, D., Theodor, R., Ramirez, L.C., and Ulick, S.: The nature of the defect in a salt-wasting disorder in Jews of Iran. J Clin Endocrinol Metab 44:279, 1977.